Study plots long-term financial impact of diabetes

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NEW ORLEANs – Between 2001 and 2013, a cohort of persons with newly diagnosed diabetes spent $3,489 more on average on medical costs in the first year after their diagnosis than they had in the year preceding it. Comparied with their diabetes-free counterparts, patients spent $6,424 more on average in the first year following diagnosis, results from a large data analysis found. In addition, during the period of 9 years before and 9 years after the diagnosis of diabetes, per capita total medical expenditures for the diabetes cohort increased annually by $382, compared with an increase of $177 for the cohort who did not have the condition.

“We know that people with diagnosed diabetes spend more on medical care than those without diagnosed diabetes because of the additional costs associated with managing diabetes and diabetes complications,” lead study author Sundar S. Shrestha, Ph.D., said in an interview in advance of the annual scientific sessions of the American Diabetes Association. “However, little information is available on how much more those with diagnosed diabetes spend after diagnosis than before diagnosis. Also, little information is available on how much more those with diagnosed diabetes spend on medical care, compared with those without diagnosed diabetes.”

Dr. Sundar S. Shrestha

Dr. Shrestha, a health economist at the Centers for Disease Control and Prevention, and his associates, analyzed the MarketScan Commercial Claims and Encounters database for the period 2001-2013 to compare the trajectory of medical expenditures (in 2013 U.S. dollars) among a diabetes cohort 9 years before and 9 years after diagnosis with a matched cohort of individuals without diabetes for U.S. adults aged 25-64 years. They defined diabetes incidence as having two or more outpatient claims 30 days apart or at least one inpatient claim with diabetes codes during the case identification period that spanned up to 2 calendar years after the first diabetes claim with at least 2 previous years without any diabetes claim.

Dr. Shrestha reported on 415,728 patient-years of data. The diabetes cohort spent an additional $51,000 on average during the 9 years before and after diagnosis, compared with their counterparts who had no diabetes diagnosis. Overall medical expenditures after diagnosis were also 2.3 times higher than before diagnosis.

“Although the additional expenditure after diagnosis was much higher for people with diagnosed diabetes, after the first year of diagnosis, it did not increase with the duration of diabetes during the study period,” Dr. Shrestha said. “However, the composition of expenditures differed, increasing for prescription drugs and decreasing for inpatient care.” He noted that the estimated excess medical expenditures described in the study indicate that “identifying those at high risk of diabetes, delaying/preventing development of diabetes through a lifestyle change program or other intervention, and managing diabetes effectively could reduce health care costs substantially.”

He acknowledged certain limitations of the study, including the fact that the data were drawn from a privately insured adult population and therefore may not be generalizable to the entire population of the United States. “Additionally, the data do not allow us to distinguish between type 1 and type 2 diabetes,” Dr. Shrestha said. He reported having no financial disclosures.